Provider Demographics
NPI:1326480138
Name:D'OLIVE BAY FAMILY CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:D'OLIVE BAY FAMILY CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WETZONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:251-621-0341
Mailing Address - Street 1:28080 US HIGHWAY 98
Mailing Address - Street 2:SUITE D
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-7005
Mailing Address - Country:US
Mailing Address - Phone:251-621-0341
Mailing Address - Fax:251-621-0340
Practice Address - Street 1:28080 US HIGHWAY 98
Practice Address - Street 2:SUITE D
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-7005
Practice Address - Country:US
Practice Address - Phone:251-621-0341
Practice Address - Fax:251-621-0340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2380111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2508023201OtherINDIVISUAL NPI